Loading...
HomeMy WebLinkAbout43700-Z OfF011rTown of Southold 7/31/2019 . P.O.Box 1179 o - o • 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40570 Date: 7/31/2019 -THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2395 King St., Orient SCTM#: 473889 See/Block/Lot: 26.-2-44 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/1/2019 pursuant to which Building Permit No. 43700 . dated 5/1/2019 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ACCESSORY IN-GROUND SWIMMING POOL, FENCED TO CODE, AS APPLIED FOR The certificate is issued to Norden,Alan&Patricia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39271 01-21-2015 PLUMBERS CERTIFICATION DATED th rize ignature �o�sU fE` TOWN OF SOUTHOLD h Gym BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 43700 Date: 5/1/2019 Permission is hereby granted to: Norden, Alan 2395 King St PO BOX 485 Orient, NY 11957 To: Construction of an in-ground swimming pool as applied for. Replaces BP# 39271 At premises located at: 2395 King St., Orient SCTM #473889 Sec/Block/Lot# 26.-2-44 Pursuant to application dated 5/1/2019 and approved by the Building Inspector. To expire on 10/30/2020. Fees: PERMIT RENEWAL $125.00 Total: $125.00 i Building ing Ins ctor Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and "pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Ll Date. l� , New Construction: Old /or Pre-existing Building: (check one) Location of Property: y- House No.}� I , Street Hamlet Owner or Owners of Property: /-\1 a-h OCA Q-n Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ aTFe_� Applicant Signature L TOWN OF SOUTHOLD o�s�FEotx�o . BUILDING DEPARTMENT y z TOWN CLERK'S OFFICE v • SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 39271 Date: 10/16/2014 Permission is hereby granted to: Norden, Alan & Norden, Patricia 2395 King St PO BOX 485 Orient, NY 11957 To: Construction of an in-ground swimming pool as applied for. At premises located at: 2395 King St, Orient SCTM #473889 Sec/Block/Lot# 26.-2-44 Pursuant to application dated 10/1/2014 and approved by the Building Inspector. To expire on 4/16/2016. Fees: IN-GROUND SWIMMING POOL $250.00 CO - SWIMMING POOL $50.00 otal: $300.00 Building In ®uTy®l � O Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 ® �Q roger.riche rt(cD-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Alan Norden Address: 2395 Kings St City: Orient St: NY Zip: 11957 Budding Permit#: 39271 Section: 26 Block: 2 Lot: 44 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor: DBA: Doroski Electric Inc License No: 2941-e SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Surrey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 1-30 A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 Twist Lock El Exit Fixtures TVSS Ll Other Equipment: in ground swimming pool to include, bonding, 1-pool light, 1-GFCI circuit breaker, 1-gas pool heater,land scape lighting in pool area Notes: Inspector Signature: <4 - Date: Jan 21 2015 81-Cert Electrical Compliance Form.xls I BOE SOUT�O! - Q cDUNi`1,� TOWN OF SOUTHOLD BUILDING DEPT.•- 765-1802 FOUNINSPECTION [ DATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: K k s DATE INSPECTOR fjf so eou TOWN-, OF,SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION , I FOUNDATIOWIST, ],ROUGH PLUMBING FOUNDATION 2ND INSULATION- FRAMING / STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION CAULKING REMARKS: DATE - INSPECTOR'Y�� a i L`7 f3f SOcou !/ryo TOWN OF SOUTHOLD BUILDING- DEPT. 765-1802 INSPECT10- [ ] FOUNDATION IST [ ] G [ ] FOUNDATION 2ND [ ] I ULATION [ l ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: C�, �q , ® � v— f� 1 ij s;-�Ak lw�t� N DATE INSPECTOR SOUI,�� TOWN OF SOUTHOLD BUILDING DEPT. C^000 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] I SULAT [ ] FRAMING /STRAPPING jZF IN A L [ j FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: Kovm ?fq 9eh o ffe t,- t s cor#--- bL, vkAw)ol,V\&tl(A )..,n cj� t'� I i vn PP�2d�'1r1�/ Ay 6 4— IcA (l, DATE INSPECTOR r �,�`,. 'f�r. �r��M r�n'� 'yrs r. .. iii. r r �ir� �x� •1}` '�. r. 3ck 4O a Us � s N yr 5il 3 sf 1 � f ow s w low rr, , ylt � I 1 g 77 t Sam - i l 7 UN .rte, ` '@` '. ; �:�, z S.t: r•.r •t b mow i 1100'T s �• V Z7, � O C)IJ to 39 ol-1 r. r e 00 . �:. .� y. s � s s 141 im fig1 0 0 �lsSS:a • 1/IUI, ROUGH RIAW=q PLUMBING 1IMSULATIONPRAN.Y. STATE ENERGY COOE I y r/ � AA io _ t li �i� b f TOWN OF SOUTHOLDs BUILDING PERMIT APPLICATION CHECKL'IST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY,11971',T "f� ,CZ _ 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502 Survey. SoutholdTow_n.NorthFo_ rkxet PERMIT NO. 3R @L7:*(Z- Check, =' Septic Form N.Y.S.D.E C. Trustees .C.O.Application- Flood Permit Examined ,20 Single&Separate - �.l Storm-Water Assessment Form Approved _ _ ,20 ®CT ® , �014 Mail to: Disapproved a/c .11 , /•�, , , BLD DEPT Phone: �;��' `7 TOWN OF SDUTH Expiration - - - _ Bui mg Ins ector i v , APPLICATION FOR BUILDING PERMIT 1 _ ,_ .µ•; • ° . .. Date 0, 20' `1- INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale.Fee according to schedule.- b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,,the Building,Inspector will issue,a Building Permit to the,applicant. Such a permit shall be kept on the premises available for inspection throughout the' -work. e.No building shall be occupied or used in whole or in part for any purpose what,so ever until the Building Inspector. issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within-18 months from such•date:'If no•zoning amendments or other`regulations affecting'the property_have been enacted in the interim,the Building Inspector may,,authorize,in.writing,the-extension of the permif for an addition six months..Thereafter;&new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town,of.Southold;Suffolk County,New,York,-and.other,applicable Laws;Ordinances or; - Regulations,for the construction of buildings;additions,or alterations or forremoval,or.demolition,as,herein described.The applicant agrees to comply with all applicable laws,,ordinances,building code,housing code,and;regulations,and to admit authorized inspectors on premises and in building for necessary inspections., (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,general contractor,electrician,pl'mber`or builder Poo Ca h � Aovl­ Name of owner of premises AA� (5 V-ay-) (As on the tax roll or latest deed) If applicant is atcorporation, signatureof duly authorized officer (Name and title of corporate officer) Builders License No. _ Plumbers License No. Electricians License No. Other Trade's`License No. ' 1. Location of land on which propose _ wok will be done: z3 °� 5 Y; �9 s r o �r� House Number Street Hamlet _ County-Tax Map No.,1000 ,Section, Block:'•: 4 Lot ` l Subdivision. Filed Map No. Lot J . ' 2. State existing use and occupancy of premises qnd intended u e and o cupan y of proposed construction: a. Existing use and,occupancy ' k^r.e- 4 b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work S 1,-•m r, V\ escription) 4. Estimated Cost 'LA o �e)d Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars ' i 1 a 6. If business, commercial or mixed,occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations-or additions:Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front Rear Depth 10. Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated ' 12.Does�proposed construction Aolate'any zoning law;'ord.m' ',e'or regulation?YES "' NO 13. Will lot be re-graded?YES } ' NO Will excess fill be removed from premises?YES!>r NO 14.Names of Owner of premises Address Phone No. Name of Architect, Address Phone No Name of Contractor Address Phone No., - 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?'*YES ` NO * IF YES,`SOUTHOLD TOWN TRUSTEES-&D.E.C:PERMITS MAY BE REQUIRED. , b.Is this property within 300'feet of a-tidal wetland?'*'YES- NO * IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any'Covenants and restrictions with respect to this property? * YES NO *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: - - - COUNTY OF�X01 ) T, ����� -'being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the C61�'I�l'a.0 r : . (Contractor,Agent, Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that,the-work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day-of 20 4LAl3RIE KAUY0PA 'I -_;Notary Public ''' NOTARY PUBLIC,STATE OF NEWYORK &Signature'bf Applicant Registration No.01 KA6205483 Qualified in SUFFOLK COUNTY Commission Expires MAY 11,2017 Scott A. Russell IJFFQZ ST 01KM WA\,T]E1K SUPERiIISOR n 1\\\1[A\1NA\G]EM[]ENT SOUTHOLD _ z 53095 Main Road-SOUTHOLD,NEW YORK 911971 Town of So u th o l d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) - ----------- -- - - --- ----- - - - DOES THIS PROJECT INVOLVE ANY OF THE (FOLLOWING: Yes No (CHECK ALL THAT APPLY) ❑YA. Clearing, grubbing, grading or stripping of land which affects more ❑than 5,000 square feet of ground surface. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. preparation on slopes which exceed 10 feet vertical rise to �100 feet of horizontal distance. ❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑E3 E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. ❑ Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes _in-kind replacement of impervious_surf aces. _.- _... If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT. (Property Owner,Design Professional,Agent,Con ractor,Other) S.C.T.M. '°: 1000 Date- / Dlsti IL I "T NAME I�[N T. Z l(1 Z Cv `� r� ✓G� �I Section Block Lot WT- dIU<1 •K<.k:t FOR B' DING DEI';11?'1' -tEN"1- USE ONLY Contact Information Reviewed By: — — — — — — — — — — — — — — — — — — U Date Property Address / Location of Cons ruction Work. — — — — — — — —E3 — — — — — — — — — Z / i Approved for processing Building Permit Stormwater Management Control Plan Not Required. ElStormwater Management Control Plan IJ Required (Forward to Engineering Department for Review) FORM SMCP-TOS MAY 2014 Town Hall Annex ,k Telephone(631)70-18W TTF, --�-------4�b8MM&iis-R"d,� (--[� rrP.C},;1 x,l l '� ' r4Q�r.rich@r���OWn.90UtC10fd,tTY.US tt�21 �q 1 1' 1s9 � ern, OCT 2 9 2014 L BUIMING DEPARTmEN, TOWN OF SOUFHOIUD roNdB1DG DEPT SOUrrIT L0 D � PLIC;A1'fOA! FOR I N REQUESTED BY: Q, ®v~o�k; Date: 16-..21 Company Name: �r.4, Name: License No.: .2 q y i .. F- _ Address: S k Al. I tq,3 Phone No.: C 31 `714 -7-C2.& JOESITE INRORIVIATI014: ("Indicates required informati®n) *Narrle: "Address° - *Cross Street: *Phone No.: Perri* No.: --32fc) Tax Map District: 1000 Secti®n:�....... Block: 2 Lot; yej *BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That Apply) _ *Is job ready for Inspection: YES / NO Rough In Final *Do you need a Tamp Cer .-I( ate: YES I NO Ternp Information (if needed) *Service Site: t Phase 3Phas® l00 150 200 300 360 400 Other `New Servia ,ohn6-,t und+ergmun'd : N6t-r ef�of Meters Change of Service, 'Overhead U9d p4l i�,f�r tl� f PAYMENT DUi=WITH APPLICATION 1 OCT 2 9 2014 82 q� �e—gtnspeCtian Form, Tf1'd;�;0 S11 i !D oc Southold Town Building Department �o�S�FFO(,�cpG P.O.Box 1179 Permit#: 39271 3 53095 Main Rd Southold,New York 11971 Permit Date: 10/16/2014 o4� o�� (631)765-1802 Expiration Date: 4/16/2016 Parcel ID: 26.2-44 BUILDING PERMIT RENEWAL LETTER Dated: 8/31/2017 Applicant: Matrix Development Location: 2395 King St, Orient Work Description: IN GROUND POOL Construction of an in-ground swimming pool as applied for. A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: Norden,Alan&Norden,Patricia Address: 2395 King St PO BOX 485 Orient,NY 11957 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department, P.O. Box 1179, Southold,New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. Southold Town Building Department gtlFFOj,�c� P.O.Box 1179 o Permit#: 39271 �Q G� 53095 Main Rd oSouthold,New York 11971 Permit Date: 10/16/2014 (631) 765-1802 Expiration Date: 4/16/2016 Parcel ID: 26.2-44 BUILDING PERMIT RENEWAL LETTER Dated: 11/15/2018 Applicant: Matrix Development Location: 2395 King St, Orient Work Description: IN GROUND POOL Construction of an in-ground swimming pool as applied for. A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: Norden, Alan&Norden, Patricia Address: 2395 King St PO BOX 485 Orient,NY 11957 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department, P.O. Box 1179, Southold, New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. SURVEYED FOR:ALAN&PATTY NORDEN LOCATED AT.ORIENT,SUFFOLK CO.,N.Y. LOT:IS DECRIBED MAP OF:AS SHOWN SCALE 1'=3(Y g S_C.T.M.#1000-025-02-W .116t 0?101 ILL �� ti G) S ` mol' G NE P��S�lA As,�i y0 � 3: " sr EC �'Fy filo.49 37 LAND FILE#45437 MUM MSA MSIUMONS 3RML.S.P.C. 11 MEROKELANE,EAST ISLIP,N.Y.,11730 PH. 1 5814688 FX 631 581-1691 DATE 11/52008 SCALE:1"=30' DRAWN BY.T.C. CA �, ��—`�- �' g v �y, n New York State Insurance Fund Workers'Compensation& Disability Benefits Specialists Since 1914 199 CHURCH STREET,NEW YORK,N Y 10007-1100 Phone (888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^A^^^^ 112399668 MATRIX DEVELOPMENT CORP 11 WOODED LANE P0BOX 1033 HAMPTON BAYS NY 11946 POLICYHOLDER CERTIFICATE HOLDER ! MATRIX DEVELOPMENT CORP i TOWN OF SOUTHOLD 11 WOODED LANE ! BUILDING DEPARTMENT P 0 BOX 1033 TOWN HALL HAMPTON BAYS NY 11946 I SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER I PERIOD COVERED BY THIS CERTIFICATE DATE Z 639 161-9 751589 02/28/2011 TO 02/28/2015 1/25/2013 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 639161-9 UNTIL 02/28/2015, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 02/28/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE NOTICE,BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. JANET BONAWANDT SECRETARY/TREASURER OF MATRIX DEVELOPMENT CORP 1 OF 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888)875-5790 VALIDATION NUMBER: 1002734706 U-26 3 499/CD47088-20/501 i MATRIA OP ID:VM CERTIFICATE OF' LIABILITY INSURANCE D 01115/20/ YY) 01115/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Bagatta Associates,Inc. PHONE FAX 823 W Jericho Turnpike Ste 1A E-MAIL No E • AICNo. Smithtown,NY 11787 ADDRESS Bagatta Associates,Inc. INSURER(S)AFFORDING COVERAGE NAIC if f INSURER A:Worcester Insurance Company 26182 INSURED Matrix Development Corp ( INSURER B:TowerGroup Companies 44300 P.O.Box 1033 INSURER C. Hampton Bays, NY 11946 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFPOLICY XP LIMITS LTR INSR WVD POLICY NUMBER MM1DD MMIDDNM GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPA00000065795H 02/01/2014 0210112015 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE FX_I OCCUR MED EXP(Any one person) $ 5,00 X Contractual Liab. PERSONAL&ADV INJURY $ 1,000+00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PED LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000 000 Ea accident , $ + B ANY AUTO CAC700397702 02/01/2014 02/01/2015 BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONWCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN T MIT ANY PROPRIETORIPARTNERIEXECUTIVEF-1N I A E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ I I i DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional'Remarks Schedule,if more space is required) Proof of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Town Hall AUTHORIZED REPRESENTATIVE Southold, NY 11971 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD :lam:-� K. +• G� . POOL ALARM GENEPAL NOTES: �� Eu.-c-� crst�= . - - • - •80 a fxc ewe, t4 0.44�t R •dexo GAt TIIIS POOL SR{ALL BP- EQUIPPED WITH AN ALAR.Nt SYSTEM 7fHE DESIGN IS BASED ON A DRtiA AICE SOIL WI7�i L£.S.S TFlalti AS FOLLOWS: 10% SILT. GROUND WATER SILALL NOT EXIST WITHIN 1ASHI S - IS CAPABLE OF DECTECIING A CHILD ENTERING CIIL WA.TE:R OF EXCAVATION- —�P1��Y»'�-'��� �L�c�P'6'Ct� _ AND GIVt'�0 AN AUDI BLE AUIR.tit WI1E1V IT DE:CI� CCS A CHILD If GROUND WATER £X1M WITHIN 6`-0` BELOW GRADE. �t�'`��T�'�L p�2�-f o a i SPECIAL DEWATERING FACILITIES WILL BE REQUIRED. ' E NTERNG WATER ,- — LS AUDIBLE POOLSIDE JsND A'C ANOTIIER LOCATION ON THE NO SUR CHARGE ALLOWED WITULN 4• —0' OF SHALLOW END PREMISES. AND 6' —0" OF DEEP E,dD• `�37Z)p t IS INSTALLED, USED AND MAIMAINED IN ACCORDANCE Tit P,ti'EI MATICALLY APPLIED CONCRETE (GUTr1TE)SHALL BE t om. >�. �,,,i H ALL CODES OF WITI{MANINACTURERS 11rMUCTIONS. 1:4 MIX WITH A AL1_�C.iMURi OF 3 A.'`1D 1R GALLONlS OF WATER PER SACK 11a:, , , d..;. i CO'"' , & TOWN CODES IS CLASSUIED BY 11NDERWRIIT-:RS LABORATORY. INC. OF CEI`SI~�? - jj 1 -7 NEW YOE,I� S I A �� Nis-OFr,n�+nlTlrl + G LAB. TO REINFORCING STEEL SILALL 88 LNTEt1iEDL1TE GRADE b0" IO I�L I`I 6.P.#t�.�_�___ AS REQUIRED At � . (OR OTHER APPROVED INDEPENDENT ) REIN BILLET DATE: GI. REFERENCE STANDARD ASTM F7.708,IDNIITLED -STANDARD STEEL WMI A �riI�+Zti1Uhi LAP OF 30 BAR DLAME PERS. �- �T FEE: ����� _..�, ��' �.../ Sw�, SPECIFICATIONS FOR POOL ALARMS'.,AS ADOPTED IN 2002 - n ` +�aneR POOL WATER flY OWNERS FILL SMUT. POOL TO BE ir.£P'T FULL MOTIF RUI!_^IP;C: :._F;,�T°,'i��IT AT , AND EDITORIALLY CORREL'1'ED t&1 JUNE 2005. P1.113LISIIFD BY DURING FREEZING N'YEATIII?R PUMP CAPACITY TO BE SUFFICIENT 765.1802 8 A1,11 TO Pi,' FOR THE ASTM IivTMNAT10NAI. 100 BAPR HARBOR DRIVE . TO ESIPTY POOL IN 24 IIOURS. FOLLOW'ING 1. S=LCIiO"eS: CONSHOHOCKEN,PA- 1942t. FILL SPOUT TO BE 314 INCH GOOSE .NECK WITH A 12"' AIR GAP 1 FOI NDATRED GO- .TWO CF�TC-�,irED I1• •,'' j, IS NOT AN AIARIM DEVICE W1001 1S LOCATED ON PERSONS BETWEEN SPOUT AND POOL WATER LINT- 2. ROUGH - FRAMIi�IG F� PLl1MSING j OR V4'ItfCll IS DEPE>ti'DE,fi ON DEVICES ON PERSONS FOR ITS 3. INSULATION PROPER OPERATION. MUST OCCUPANCY OR ! 4. FINAL - COi 1°TRUGT I THE POOL ALARM MUST BE CAPABLE OF DECTECTING ENTRY EE C0r,^PLETE FOR C.O- I " �" USE IS UNLAWFUL Q�1T0 T1{E WATER AT A•ti`Y PONT ON T]IE: SURFACE: OF THE POOL. ALL CONSTRUCTION SHALL MEET IE% I LF NECESSARY TO PROVIDE DETECTION AT EVERY POINT. MORE. REQUIREMENTS OF TIME CODES OF NE�v IiALL BF INSTALLED. YORK STATE. NOT RUCT ONSIBLE ERROOR WITHOUT CERTIFICATE T�{A.y o�E ALARtit s OF OCCUPANCY DESIGN OR CONSTRUCTION POOL ALARNi SHALL BE POOL GUARD MODEL PGRy4-2 OR EQUAL AND CO.WLIES WITH N.Y.S. BUILDING CODE TITLE: 14 SECTION 1221.3 MEETLNG ASTM F220s. _ veirsSTD{ATO CODE 1 �,tZ6 (r-t•� A tj C O P_ F C /SEA �P• ENCLOSE POO , tit-L UPON COMPLETION 1 �o-rf• c�►t,• y/oor BEFORE"WATER" 1 1 A-4 r;p -_ -- ...t.". ----�___�_��..��. ...�._._.,.��: �.=—•-..--.—. . •pa�t�vt.aT?rC.. � ® G i i .A� /' 1 j; ENTRAPMENT PROTECTION FOR SW1MMING POOL AND SFA SUCTION OUTLETS AG 106.1 General. Sucti'on autlets shall u- dtnigned to por- i CJECi f O� �'� 7 MirS• duce ntculminn throe pout the i or• �x. Su.^Ic oudet Sys. ---- Arc r L v G CaM f;1AwT- Y t 1 a _ Semi.Such ds autotnlne vacuum cleaner%y,tems,at.•Ahtr Nuch multiple suction outlets whether kolatcd by vtlltes otmhet. • wise still be Protected rMainst user entrapment. AG1062 Suction fittings. All Pool and Sri suction outlets ,0' Sha.11jh'p*rnidedwith aco%.c ihat conform cwithANSUASME t ' �- C• A 1 12.14.FM. or a 12 m 1. drain grate .w lager, tx an ap- o{�x prrveJ channel drain system r Exetption: Surtue it AG 106.3 Atm upher c vacuum rrtttf syuem requjrtd. All Cc-. • C-t, _ belt! t:nd+e ttngje or multiple outlet circulation system%%ull :i ,,- GSL `�u•nrrL be equipped with rtmosoheric vacuum relief should Sme aov 4 re ®� ""<- 2a ryC 4hsJ�' ern 1X3ledtttereintxc:n"missingtx broken Such vu-uumre- + ' r"e"z WA*lr S6KV k- bet evsrtmk shall include at laid one apptased or engineered • ter' t� method of the rype.peel:sed bercty u iolluwc. e - 1. Safety .,Acuum tricue neem eoniorm,ng to ASPAE An appmvej grrvity drrin:;e s?stem W t O t+c�n, AG 106.4 Dunt drain separation.SinPle tit ntultiplc pump air• Otr. { l.5`•O• > �=0• �° tNL�S eulation Mlemt chill he provided with a �ninimtun of two(21 •a 9 w►rr %uc;)on outl,'B of the 6pproved q pe.A minimum horizontal or e tact _t I t►..tf K:/1l.,. 10') OG }e�+e �, t'4 rtttical di>lWnte of three t31 feet .hill .,eparate such amen rE,,U /fit.(, vC.Ar• 10 CG SpaSr The_ce .u:.non nutlet& shell bei piped t•o that water b, drawn through them stmuttanenucly through a vactnim relief t'11 e r',ocjta4 1 O"t OC EACK a!A� protected line to trx pump or pumps. AG 106.5 Pod eiesntr fltttnypt. «%ere pr.svtded. v3cvun ur al,k f.F -C�AU — —�I, QIP1NG 'JGHI;MA-nC p<etsurrcleaner fininp(SlchtillbeIN:n(edininaccetsiblepn►"• dtG2nt'DuLG �o �� uontt:► at lcnu tGl in:hes t:a.t rpt grrnte; thrtt twrh•: .I. inches below•the tn,rticnt:,n,tperaunna.l «atcr:evo; or as tutu . t _401tXS VA4�� tul�hrncnt to the sl►un,nertit. G•To %4"1 ov tt-fu' twC' ' `' - � �5•�P cv til COX- I j • EREO AIR? -NOK,0914 � 9)b51-tGe MAr)e)4 �Jav>✓Ia �P�,o C. yq�Fc� ZV 9* Y_11AAC .90ri • P a,boy-boy- 1 ds!+ 11 Woet7llp 4 n �� RONALD C HANNA 00C "o. Nom;PSC,,, t"t� Oa.s�c t� rpt_ s•Y.�• G s'�� �q ARCHITECT �2.01d 761 COAT ES AVE. SUITE 15 CIZ ej 110LBROOK. N.Y. 11741 a 631 285 - 7870 a S�rtM�r.t�� �t, OC-1-AIc.o